title: Long-term Outcomes of Carotid Artery Stenting for Radiation-Associated Stenosis.
abstract: BACKGROUND
  In Taiwan, the prevalence of head and neck cancer is relatively high. Because radiation-associated carotid stenosis is a significant risk factor for stroke, carotid artery stenting (CAS), instead of carotid endarterectomy, is indicated in patients with radiation-associated carotid stenosis. We sought to evaluate the effect of neck radiotherapy (XRT) on the long-term outcome of patients undergoing CAS.
  
  
  METHODS
  From March 2001 to November 2011, 147 CAS procedures were performed on 129 patients (n = 43 for XRT, n = 86 for non-XRT). Mean follow-up was 42.7 ± 20.5 months (median: 52 months; range: 1-60 months). Duplex velocity criterion for > 50% restenosis after CAS was defined as peak systolic velocity > 175 cm/s. Endpoints included 5-year freedom from mortality, ipsilateral recurrent stroke, and major adverse cardiovascular events (MACE).
  
  
  RESULTS
  The mean age of XRT patients was significantly lesser than that of non-XRT patients (61 ± 8 vs. 71 ± 8, p < 0.001). There was significantly less coronary artery disease and other cardiovascular co-morbidities in XRT patients. No significant differences were noted in the composite 30-day ipsilateral stroke/myocardial infarction/mortality (XRT: 8.6% vs. non-XRT: 6%, p > 0.05) and 5-year freedom from mortality, ipsilateral recurrent stroke, and MACE (p > 0.05) between the two groups. Intra-stent carotid restenosis > 50% was significantly higher in the XRT group on follow-up.
  
  
  CONCLUSIONS
  Long-term outcomes of CAS for radiation-associated stenosis were not altered by a history of neck XRT, except for asymptomatic carotid restenosis.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Min-Ping
authors.initials: MP
authors.lastname: Huang
authors.forename: Hsiu-Yu
authors.initials: HY
authors.lastname: Fang
authors.forename: Chung-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Teng-Yeow
authors.initials: TY
authors.lastname: Tan
authors.forename: Yeh-Lin
authors.initials: YL
authors.lastname: Kuo
authors.forename: I-Chang
authors.initials: IC
authors.lastname: Hsieh
authors.forename: Hon-Kan
authors.initials: HK
authors.lastname: Yip
authors.forename: Chiung-Jen
authors.initials: CJ
authors.lastname: Wu
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000528:radiation effects*; D011832:Radiation Injuries / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects; D015607:Stents